Provider Demographics
NPI:1255066148
Name:HARDY, MONICA LEE (PEER SUPPORTER)
Entity type:Individual
Prefix:
First Name:MONICA
Middle Name:LEE
Last Name:HARDY
Suffix:
Gender:F
Credentials:PEER SUPPORTER
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:2020 TAYLOR RD APT 818
Mailing Address - Street 2:
Mailing Address - City:EAST CLEVELAND
Mailing Address - State:OH
Mailing Address - Zip Code:44112-2945
Mailing Address - Country:US
Mailing Address - Phone:216-309-3090
Mailing Address - Fax:
Practice Address - Street 1:2020 TAYLOR RD APT 818
Practice Address - Street 2:
Practice Address - City:EAST CLEVELAND
Practice Address - State:OH
Practice Address - Zip Code:44112-2945
Practice Address - Country:US
Practice Address - Phone:216-309-3090
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2022-07-23
Last Update Date:2022-07-23
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
OHAPS.003368175T00000X, 101YM0800X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes175T00000XOther Service ProvidersPeer Specialist
No101YM0800XBehavioral Health & Social Service ProvidersCounselorMental Health